Public Health Addiction Policy

January 4, 2015

By Terence T. Gorski
Author

The time is getting right for the nation, on a state-by-state basis, to shift from a War on Drugs Policy to a Public Health Addiction Policy.

The motto of the War On Drugs Is:
GET TOUGH, BE DUMB

The War on drugs is a GET TOUGH, BE DUMB approach to the international effort manage the addiction epidemic.

The motto of the Public Health Addiction Policy is GET TOUGH, BE SMART

The Public Health Addiction Policy is a GET TOUGH, BE SMART approach that used public health policies, that were do successful in managing the cigarette addiction problem. Early Intervention, Treatment, and Relapse Prevention needs to be the leading approach, supported by law enforcement efforts.

ADDICTION IS A PUBLIC HEALTH ISSUE

Addiction is a public health issue yet the Center for Disease Control (CDC) does not mention it as a top priority. The closest it comes is to address public health approaches to tobacco and smoking. This has lead to a reduction in smoking.

It is time to shift more responsibility to the CDC for managing the alcohol and drug abuse epidemic.

THE GOAL: BUILDING SOBER COMMUNITIES

The goal should be building sober and responsible communities by promoting sober and responsible lifestyles both as prevention and to provide a supportive environment for recovering people.

Please repost this blog and share it with friends, family, and legislators.

Gorski Books. www.relapse.org


Kava and Relapse

January 1, 2015

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By Terence T. Gorski
Author

This information on Kava is reproduced from a Medline Article http://m.medlineplus.gov/druginfo/natural/872.html

Introduction

Kava is mind altering and mood altering substance that produces an effect on the brain similar to sedative drugs such as Librium or Valium. They are cross addictive with other mood altering drugs. Many people use Kava as they move into relapse process thinking that it will be a free high with no adverse consequence.

Many treatment programs use drug testing regimes that will detect and report Kava use. Lava impairs judgment and impulse control and generally does not produce the desired high or the desired mood altering effect of the drug of choice.

As a result of impaired judgment or impulse control it is easier to rationalize going back to the use of their drug of choice. Using Kava is the start of active drug use episode. It is usually preceded by many early relapse warning signs.

You can do an evaluation of your relapse risk using The Aware Questionnaire

Midline Article On Kava

Scientific name: Piper methysticum
Rank: Species
Higher classification: Piper

Kava or kava-kava is a crop of the western Pacific. The name kava is from Tongan and Marquesan; other names for kava include ʻawa, ava, yaqona, and sakau. The roots of the plant are used to produce a drink with sedative and anesthetic properties.

What is kava?
Kava—or kava kava—is a root found on South Pacific islands. Islanders have used kava as medicine and in ceremonies for centuries.

Kava has a calming effect, producing brain wave changes similar to changes that occur with calming medicines such as diazepam (Valium, for example). Kava also can prevent convulsions and relax muscles. Although kava is not addictive, its effect may decrease with use.

Traditionally prepared as a tea, kava root is also available as a dietary supplement in powder and tincture (extract in alcohol) forms.

What is kava used for?
Kava’s calming effect may relieve anxiety, restlessness, sleeplessness, and stress-related symptoms such as muscle tension or spasm. Kava may also relieve pain.

When taken for anxiety or stress, kava does not interfere with mental sharpness. When taken for sleep problems, kava promotes deep sleep without affecting restful REM sleep.

Kava may be used instead of prescription antianxiety drugs, such as benzodiazepines and tricyclic antidepressants. Kava should never be taken with these prescription drugs. Avoid using alcohol when taking kava.

Is kava safe?
Kava may have severe side effects and should not be used by everyone. Kava has caused liver failure in previously healthy people. You should not use kava for longer than 3 months without consulting your doctor.

Before you use kava, consider that it:

Should not be combined with alcohol or psychotropic medicines. Psychotropic medicines are used to treat psychiatric disorders or illnesses and include antidepressants and mood stabilizers. Alcohol exaggerates kava’s sedating effect.
Can affect how fast you react, making it unsafe to drive or use heavy machinery.
May gradually be less powerful as you use it.
Eventually may cause temporary yellowing of skin, hair, and nails.
Can cause an allergic skin reaction (rare).
Long-term kava use may result in:

Liver problems.
Shortness of breath (reversible).
Scaly rash (reversible).
Facial puffiness or swelling (reversible).
The U.S. Food and Drug Administration (FDA) has investigated whether using dietary supplements containing kava is associated with liver illness. Reports from Germany and Switzerland about kava causing serious liver problems have led to the recent removal of these products from shelves in Britain. Other countries have advised consumers to avoid using kava until further information is available.

In the United States, the FDA advises people who have liver disease or liver problems, or people who are taking medicines that can affect the liver, to consult a doctor or pharmacist before using products that contain kava. People who use a dietary supplement that contains kava and experience signs of illness should consult a doctor. Symptoms of serious liver disease include brown urine as well as yellowing of the skin or of the whites of the eyes. Other symptoms of liver disease may include nausea, vomiting, light-colored stools, unusual tiredness, weakness, stomach or abdominal pain, and loss of appetite.

The FDA does not regulate dietary supplements in the same way it regulates medicine. A dietary supplement can be sold with limited or no research on how well it works.

Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.

When using dietary supplements, keep in mind the following:

Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse.
The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.

Reference:
1. http://m.medlineplus.gov/druginfo/natural/872.html

2. http://www.thefix.com/content/mood-and-mind-altering-substances00417?page=all

Gorski Books


Relapse Prevention Therapy (RPT) – An Affordable Evidence-based Practice

November 8, 2014

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By Terence T. Gorski, Author

 

Relapse Prevention Therapy (RPT) is an Evidence-based practiced that is recognized by both the National Registry of Evidence-based Programs and Practices (NREPP) and the National Institute of Drug Abuse. This is important because relapse following drug treatment is quite common and a collection of tools have been forged into a system for both preventing relapse and stopping it quickly should it occur. “RPT is a behavioral self-control program that teaches individuals how to anticipate and cope with the potential for relapse” (NREPP). In addition, RPT serves to normalize relapse as part of the overall recovery process, thus reducing the negative feelings and behaviors that result from a setback. RPT also provided relapse tools and techniques that patients learn early in treatment that can stop relapse quickly should it occur.

The GORSKI-CENAPS Model of RPT brings proven evidence-based practices to recovery and relapse prevention by providing effective and easy to use methods for identifying and managing early relapse warning signs and high risk situations. It also presents methods for planning to stop relapse quickly should it occur. All of the key practices of evidenced-based Relapse Prevention Therapy (RPT) are made available in practical and easy to use workbooks. Training is available to teach the most effective ways to make use the workbooks in individual and group therapy and in support groups. There is also an internationally registry of Certified Relapse Prevention Specialists (CRPS) that are trained to support RPT program implementation.

The Research Supporting RPT Effectiveness

Prevention (RP) is an evidence-based intervention. There is compelling evidence in the literature documenting its effectiveness.

First, let’s look at the results of a meta-analysis of 26 published and unpublished studies with 70 hypothesis tests representing a sample of 9,504 participants. (Irvin et al, 1999)

  • Relapse Prevention (RP) was found to be a widely adopted cognitive-behavioral treatment (CBT) for alcohol, smoking, and other substance use.
  • RP was generally effective, particularly for alcohol problems.
  • RP was most effective with alcohol or polysubstance use disorders combined with the adjunctive use of medication

Validation of Gorski’s Relapse Warning Signs

Though it has enjoyed widespread popularity, Gorski’s post-acute withdrawal syndrome (PAWS) model of relapse has been subjected to little scientific scrutiny. A scale to operationalize Gorski’s 37 warning signs was developed and tested in a larger prospective study of predictors of relapse. Of central interest were: (1) whether the warning signs hypothesized by Gorski are interrelated in a meaningful single factor and (2) whether the hypothesized syndrome would accurately predict subsequent relapses.

A sample of 122 individuals (84 men) entering treatment for alcohol problems was followed at 2-month intervals for 1 year. The Assessment of Warning-signs of Relapse (AWARE) scale was administered at each assessment point, and the occurrence of both slips (any drinking) and relapses (heavy drinking) was monitored during each subsequent 2-month interval. Principal factor analysis was used to study the factor structure of the warning signs.

The results showed that: (1) Of the 37 warning signs, 28 clustered as a robust single factor with excellent internal consistency (Cronbach’s alpha: 0.92-0.93); (2) A conservative evaluation of test-retest stability across 2-month intervals estimated reliability at r = 0.80. (3) After covarying for prior drinking status, clients’ AWARE scores significantly predicted subsequent slips and relapses. Relapse rates for clients with highest AWARE scores, as projected by regression equations, were 33 to 46 percentage points higher than those for clients with lowest AWARE scores, after taking into account prior drinking status.

The conclusion is that this scale of Gorski’s warning signs appears to be a reliable and valid predictor of alcohol relapses. (J. Stud. Alcohol 61: 759-765, 2000)

Relapse Prevention (RP): Controlled Clinical Trials (Carroll 1996)

(1) More than 24 randomized controlled trials have evaluated the effectiveness of cognitive-behavioral relapse prevention treatment on substance use outcomes among adult smokers, alcohol, cocaine, marijuana, and other types of substance abusers. Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation,

(2) There is evidence for the effectiveness of relapse prevention compared with no-treatment controls across all drug categories.

(3) Relapse Prevention is most effective at:

  • Treating patients with long histories of chronic relapse after attempting recovery with other treatment methods.
  • Maintaining the positive effects of improvements made during treatment (enhanced durability of effects)
  • Reducing the length and severity of damage caused by relapse episodes when they occur;

(4)      The positive effects of RP are enhanced by patient-treatment matching.

(5) Patient-treatment matching improves outcomes for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity.

Manualized Treatment

Manualized Treatment Improves Effectiveness of treatment (i.e. increases recovery rates, decreases relapse rates, and produces shorter less destructive relapse episodes. The results are achieved while reducing time in therapy.

The primary treatment manuals that help produce these outcomes are:

  1. Starting Recovery With Relapse Prevention Workbook: A workbook designed to integrate basic relapse prevention principles in to the first attempts at addiction recovery.
  2. Cognitive Restructuring for Addiction Workbook: A workbook designed to teach and apply the basic recovery skills of thought management, feeling management, behavior management, impulse control, the use of mental imagery, and a serious of relaxation methods, including mindfulness meditation, that has been proven to enhance the effectiveness of the cognitive component of relapse prevention. This work allows an easy application of RPT methods to a wide variety of additive and mental health problems.
  3. Relapse Prevention Counseling (RPC) Workbook: This is a guide for understanding and managing craving and high risk situations to avoid relapse during the critical first ninety days of recovery.
  4. Relapse Prevention Therapy (RPT) Workbook: This is a guide for helping recovering people with a stable recovery program to identify and manage the personality and lifestyle problems that can so must pain and dysfunction in recovery that self-medication seems like a positive choice. This workbook takes RPT to a deep psychotherapy level.
  5. Problem Solving Group Therapy (PSGT): There are two simple guidelines for using RPT in problem solving groups. There is a Participant Guide to prepare group members with easy to understand information on how to succeed at group therapy and a group leader guide giving in-depth instruction how to start, conduct, and manage common problems that occur in problem solving groups.

When these five practical tools are brought together into a well designed and comprehensive treatment program the quality of care, moral of the staff, and positive long-term outcomes of treatment tend to improve.

WORKBOOKS  USING RELAPSE PREVENTION THERAPY (RPT) – AN EVIDENCE-BASED PRACTICE  http://wp.me/p11fHz-7s

References

The CENAPS Model of Relapse Prevention was originally developed by Terence T. Gorski and continually updated to integrate new research findings. (Gorski 1990, )

Carroll, Kathleen M., Relapse prevention as a psychosocial treatment: A review of controlled clinical trials. Experimental and Clinical Psychopharmacology, Vol 4(1), Feb 1996, 46-54.

Gorski, Terence T., The CENAPS Model of Relapse Prevention: Basic Principles and Procedures, Journal of Psychoactive Drugs, Vol. 22, Issue 2, 1990, pages 125- 133, ON THE INTERNET: http://www.tandfonline.com/doi/abs/10.1080/02791072.1990.10472538

Irvin, Jennifer E.; Bowers, Clint A.; Dunn, Michael E.; Wang, Efficacy of relapse prevention: A meta-analytic review. Journal of Consulting and Clinical Psychology, Vol 67(4), Aug 1999, 563-570.

Miller, William R. and Harris, Richard J.  A Simple Scale of Gorski’s Warning Signs for Relapse, Journal of Studies on Alcohol and Drugs, Volume 61, 2000, Issue 5: September 2000 ON THE INTERNET: http://www.jsad.com/jsad/article/A_Simple_Scale_of_Gorskis_Warning_Signs_for_Relapse/814.html

 

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Poison As A Preferred Pleasure 

August 16, 2014

969274_625783080787533_1366431777_nBy Terence T. Gorski, Author

I am constantly amazed by how many people view alcohol and marihuana as harmless. Even more frightening is the willingness of people of all ages to put unknown substances into their bodies that are produced by criminals who give the promise of getting high.

All psychoactive chemicals change mood by directly changing how the brain works. Small doses of brain-altering chemicals can cause serious problems with the ability to think clearly, manage feelings and emotions, remember things, use good judgment and control destructive impulses.

The brain can recovery most of the time, but not all if the time. In the best of circumstances the recovery of the brain usually happens slowly.

I suggest it is good idea to be very careful about the things we put into our bodies that can damage the brain. In make this suggestion with the same level of seriousness that I suggest you always wear a parachute when you jump out of an airplane.

“I have never used any mind altering drug that was not pharmaceutical grade. People who put drugs of unknown composition and purity in their bodies are either ignorant (they don’t know the real risks to the brain and mind), stupid (they know the risk and choose to ignore it), or addicted (they know the risk, want to stop, but find that they can’t). ~ Timothy Leary, in a private conversation with Terence T. Gorski


Marijuana Addiction: Integrating DSM IV, DSM V, and the GORSKI-CENAPS MODEL

July 15, 2014

By Terence T. Gorski, Author
GORSKI BOOKS

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Warning: Continued use of this substance may lead to continued use of this substance.

In this brief article I will define critical terms needed to understand the nature and severity of withdrawal from mind altering drugs and then I will present the initial recommendations for defining the symptoms of cannabis withdrawal in the DSM-V as of December 20, 2010.

The Diagnostic and Statistical Manual Fifth Edition (DSM-5) is proposing that recent research shows that people who regularly use Cannabis (Marijuana) can develop both dependence and withdrawal. This withdrawal syndrome has been clinical observed for decades in regular, heavy, and long term users of cannabis. Although I disagree with the symptom formulation, it is a major step forward to acknowledge that a marijuana addict can and often experience withdrawal symptoms.

My major critique of the symptoms describes are the absence of the following symptoms frequently reported by marijuana addicts: (1) Difficulty in paying attention or staying task focused for more the a few moments; (2) the tendency to dissociate or entered a non focused state of consciousness unpredictably during the withdrawal period. In the past I have referred to this as “the vacant stare phenomena; and (3) a profound sense of lethargy and lack of interest or motivation which is often described as an amotivational syndrome.

It is important to remember that in the DSM-V dependence and withdrawal are not definitive indicators of addiction to any drug. The definitive indicator of addiction is what DSM-IV calls a pattern of compulsive use, in other words the need to continue to use the drug in spite of adverse consequences and or the desire to stop. This pattern of compulsive use can occur with or without dependence and withdrawal. It is also possible to develop dependence and withdrawal on prescription drugs, including antidepressants and pain killers, without becoming addicted to them.
To exhibit cannabis withdrawal, people usually need to be using cannabis regularly (which refers to the frequency, which refers to a regular and predictability of pattern of use; heavily, which refers to the quantity or amount used during an typical episode of use, and duration, which refers to the length of time a person has been using in the same pattern.
The term dependence is defined as the need to use a substance in order to function normally physically, psychologically, and socially.
The term tolerance is defined as the need to use a drug more frequently and in greater quantities in order to be able to function normally. Withdrawal is a set of symptoms ranging from mild to disabling according to The Gorski Symptom Severity Scale.

The Gorski Symptom Severity Scale was developed by Terence T. Gorski as part of the GORSKI-CENAPS Model of Recovery and Relapse Prevention. It uses a 10 point severity rating scale to measure severity of symptoms based upon the amount of disruption a group of symptoms causes to the ability to perform basic acts of daily living. The scale uses four general categories of severity: mild, moderate; severe; and disabling. These general categories of severity are integrated with a ten point numerical rating of the severity level. They are as follows:

1. Mild – (Level 1, 2 & 3 on the severity scale) means that the symptoms are present and experienced as an energy draining nuisance, but normal functioning can be maintained in all areas of life with extra effort;

The terminology used in DSM IV and IV that compares with mild severity is clinically significant distress.

2. Moderate – (Level 4, 5 & 6 on the severity scale) means that the symptoms are present and require so much energy to manage them that normal functioning cannot be maintained in all areas. As a result people with mildly impairing symptoms begin selecting the most important life areas to maintain and beginning letting other less important areas go;

3. Severe – (level 7, 8, & 9) means that the symptoms are so severe and disruptive that the quality of life is affected in all areas in spite of using extra effort to function normally. The person can still maintain the appearance of a normal life, but it is apparent they are struggling and not doing well; disabling – (level 10) means the person is unable to function effectively in any area of life. They cannot maintain a job, intimate relationship, parenting responsibility. regular self-care activities, or friendships.

The DSM IV and V combine the Gorski Severity Scale levels 4 – 10 under the description of “impairment in social, occupational, or other important areas of functioning.”

The DSM-IVR and the DSM-V list a description of each symptom. This is a quantitative description answering the question “is the symptom present” but DSM does not clearly designate frequency or severity of symptoms. As a result, only the number of discrete symptoms is used to arrive at an overall diagnostic judgment.
The criteria for determining if people are experiencing withdrawal symptoms, according to the DSM-V working group are:

A. Cessation of cannabis use that has been heavy and prolonged

B. Three (3) or more of the following develop within several days after Criterion A
1. Irritability, anger or aggression
2. Nervousness or anxiety
3. Sleep difficulty (insomnia)
4. Decreased appetite or weight loss
5. Restlessness
6. Depressed mood
7. Physical symptoms causing significant discomfort: must report at least one of the following:
– stomach pain,
– shakiness/tremors,
– sweating,
– fever,
– chills,
– headache

Additional Criteria B Symptoms Recommended by Terence T. Gorski (Not included in DSM-V):

(1) Difficulty in paying attention or staying task focused for more the a few moments;

(2) the tendency to dissociate or entered a non focused state of consciousness unpredictably during the withdrawal period. In the past I have referred to this as the vacant stare phenomena; and

(3) a profound sense of lethargy and lack of interest or motivation which is often described as an amotivational syndrome.

C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

D. The symptoms are not due to a general medical condition and are not better accounted for by another disorder

Original Publication as a FaceBook Note:


PTSD and Addiction: A Cognitive Restructuring Approach

January 11, 2014
By Terence T. Gorski, Author
June 22, 2013
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Recovery Is Possible With
Cognitive Restructuring

 WHEN  TREATING PTSD AND ADDICTION, I don’t use a single approach – I use a consistent set of principles and practices. I strive to be sensitive and adaptive to the emerging needs of patients in the moment. The key seems to be a balance of flexibility and consistency.  Everyone responds in a uniquely personal way in learning to understand and manage PTSD. I like the idea that and the PTSD recovery process results in Post Traumatic Growth. People don’t just overcome their symptoms. They grow and change in positive ways.

PTSD ASSESSSMENT – A CRITICAL FIRST STEP

First I do a comprehensive assessment of PTSD. This includes an analysis of presenting problems, a life history, and a history of treatment and recovery. I include efforts at self-help to be important. Most people try everything they know to get a handle on their PTSD before seeking any formal or professional help.

ADDICTION ASSESSMENT – NOT A LUXURY, A NECESSITY

If the assessment provides confirmation of active PTSD symptoms, I do a comprehensive addiction assessment because addiction is so common in patients with PTSD. If the addiction is not identified and treated concurrently, the PTSD treatment can make the addiction symptoms worse, and the addiction symptoms can prevent patients from benefiting from the treatment/recovery of PTSD.

PSYCHO-EDUCATION – TEACHING A LANGUAGE OF RECOVERY

Then I use psycho-education to give people a new cognitive frame of reference about PTSD. This is extremely important because, although most people are familiar with the general idea of PTSD, most lack accurate information or a useful way of understanding the symptoms and the pathways to recovery.

SURVIVORS – NOT VICTIMS

The most important thing I want to teach is that patients are trauma survivors, not trauma victims. I also want to be sure that the trauma is over. You work differently with PTSD if the trauma is still ongoing It makes a difference if: a soldier needs to return to combat or is home from the war; if a battered child is still living under the control of violent parent and will have to go home; if the abused spouse is out of the marriage or still involved due to children or financial issues; if the person is in prison and going back to the cell block or if they have been released. If they are actively involved in an ongoing trauma teach survival and coping skills, safety plans, and ways to responsible get out and get safe.

GET PATIENTS SOME INITIAL RELIEF FROM PAIN

The first goal is to provide relief for the most painful mediate symptoms. This often involves referral for EMDR. I am not skilled with this method, but many patients find it helpful. This also involves basic training in relaxation, diet, and exercise as a part of overall stress management.

THE LIFE AND SYMPTOMS HISTORY – A COLLABORATIVE APPROACH

Then I do a guided life and symptom history so people can see how symptoms have affected their life negatively through pain, problems, and losses; and positively through a process of making decisions that lead to positive change, growth, and development. This is a positive psychology intervention called Post Traumatic Growth (PSG).

THE COMPREHENSIVE SYMPTOM LIST

I develop a comprehensive list of the PTSD symptoms that patients are struggling with. This often involves showing them a list of symptoms because they lack the words or language to describe what they are experiencing. It is easy for me to forget how important it is to give patients a language of recovery so they can identify and communicate their experiences.

Once I have a comprehensive symptom list, I ask patients to evaluate the frequency (how often) and severity (how disruptive) the symptoms tend to be.  Then explore each symptom. First I want them to tell me real-life stories about what happened when they experienced each symptoms. I like to get at least two stories about each – one story in which they managed it pretty well, and one story in which they managed it poorly. This helps them to take ownership of their symptoms and get a feel for the new language they are learning. I get stress enough how important I feel this process by relating symptoms to actual lived experiences is for most patients.

I look for patterns of symptoms. Many symptoms appear in clusters that are activated by the same trigger event and once they appear, they mutual reinforce and intensify each other. I treat these symptom clusters as a single symptom and help patients to find a meaningful name it.

STRENGTH-BASED – WHAT ARE YOU DOING RIGHT

I make it a point to discuss how patients have managed to survive up to this point. I want to find periods of time when they have successfully managed their symptoms or been symptoms free. What were they doing at those times. What was going on or not going in their lives. What thoughts, feelings, behaviors, and social styles are associated with successfully coping with the symptoms?

THE IDEA OF PTSD SYMPTOM EPISODES

I also like to introduce the concept of PTSD symptoms episodes – moments in time when the symptoms get turned on by triggers and turned off by things like rest and safe environments. The idea is that the symptoms are not always there. Most patients believe that they are, but they are usually wrong. The symptoms are usually turned on some of the time and turned off at other times. Once a symptoms episode is activated by a trigger, it starts, runs a cycle, and then ends or significantly diminishes in intensity. Know that it will end gives strength in facing the symptoms. Naming the symptoms identifies the enemies or the monsters to be dealt with. At the very least, at some times the symptoms are less severe and more manageable than at other times.

SYMPTOM SELF-MONITORING

I encourage patients to do conscious self-monitoring o their symptoms at least four times per day (breakfast, lunch, dinner, and before bed) and note the specific symptoms experienced, how severe the symptom is, what is happening that is making it more severe, and what could be done to make it a little bit less severe. This starts patients on a journey of Post Traumatic Growth by showing them they are not totally at the mercy of these symptoms — that they can choose to do things to make their symptoms a little bit better or a little worse.

FLASHBACKS – TEACHING PATIENT TO GET OUT SAFELY

I find that many patients are fearful of the flashback and dissociative states that they get into that are often a part of PTSD. They fear that if they get into these states they will fall into a bottomless black pit and never be able to crawl out again. This is why a believe so many people are afraid to start talking about past experiences or the triggers that activate symptoms. They are afraid that once the symptoms start they won’t stop.

FINDING A SAFE PLACE INSIDE YOURSELF

To counter this, I like to have patients find a safe-memory or fantasy that they can go to and practice going there when they are feeling pretty good. I want them to learn and practice relaxation exercises that work for them. I give them a smorgasbord of relaxation methods to choose from. Giving choices, it seems, reduces resistance. I also avoid “one size fits all” methods of relaxation — but no methods really do work for everyone. I avoid using guided imagery at first because I find it unpredictable. Once patients relax and engage their imagery processes, they often are vulnerable to intrusive thoughts, feelings, and flashbacks.

IMMEDIATE RELAXATION METHODS – CHOICE AND SAFETY

I like to teach centering, deep-breathing, and mindful (detached) awareness, I want to be sure that patients learn how to get back into the here and now and stop intrusive symptoms as soon as they start.

I avoid what I call “big bang catharsis techniques” which take the patients quickly into deeply re-experiencing the memories of trauma. I have just had too many b ad experiences with patients regressing and getting worse as a result of these techniques. I personally don’t find using them worth the risk.

I would rather take patients into the memories as they emerge in the assessment and recovery skills training process. I want to be sure that patients have the ability to stop and crawl out of the experience and get back into a tight anchor with here-and-now-reality.

SUPPORT NETWORKS 0 CRITICALLY IMPORTANT

I also focus on building support networks of people, places, and things that can be used when things get tough. Simple things like: Who can you call if you need to talk? Who should you avoid if your symptoms are bad in the moment? What can you do that will help? What should you avoid doing because it will make things worse? I am especially concerned about having a support systems that can be used during the night. This is when the symptoms tend to be more intense and the support less available.

COGNITIVE RESTRUCTURING – TFUAR MANAGEMENT

The general structure I wrap these general principles of cognitive restructuring. I use the word cognitive to mean total information processing with the brain and the mind. This involves Thoughts (T), Feelings (F), Urges (U), actions (A), and relationships. It also involves subtle intuitions and openness to spiritual experiences which seem to be very common in people who survive trauma. using a cognitive restructuring process. I ask patients to complete these sentence stems, or I turn them into open-ended questions. Using active listing is critical. Patients must feel listened to, understood, taken seriously and affirmed as a person. This process turns a sterile and “objective” assessment into a highly personalized and collaborative self-assessment.

COGNITIVE RESTRUCTURING FOR PTSD

Here is a general structure for the process:

1.  The symptom that I am experiencing is …

2.  When I experience this symptom I tend to think …

  • A more helpful way of thinking might be ….

3.   When I experience this symptom I tend to feel …

  • A more helpful way of managing those feelings might be ….

4.  When I experience this symptom I tend to manage it by doing the following things …

  • A more helpful behavioral strategy for managing this symptom might be ….

5.  When I experience this symptom what I do to try to get help from other important people in my life is …

  • A more helpful strategy for getting the help and support if others in managing this symptom might be ….

6.   he overall daily plan I have for managing my PTSD recovery is …

  • Some ways of making my recovery plan more helpful for me might be …

A SIMPLISTIC SKELETON OF A COMPLEX PROCESS 

This is a simplistic skeleton of the basic principles and practices of a cognitive restructuring approach for PTSD. This sketch, of course, just covers some of the steps on the critical path to recovery and relapse prevention. It also presents my preferences as a therapist based upon my past experiences with clients. I am sharing this as a personal report on lessons learned.

 Gorski Books


The New Opiate Addict

January 11, 2014

By Terence T. Gorski, Author
January 11, 2014

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Men Get Addicted

A Profile of the New Opiate Addict

There is an old stereotype of opiate addicts painting them as old-school street junkies who over-dose in alleys with needles in their arms. This stereotype is not only wrong – it is dangerous. It deters people from recognizing the new opiates, especially prescription pain-killers and their non-medical use, and the new opiate addicts who are thirty-something in age, largely employed even in this faltering economy, and spending one-third of their annual income of about $53,000 per year supporting their opiate addiction.

siobhan-morse

Siobhan A. Morse, Researcher

I developed this snapshot of the new opiate addict from a research study by Siobhan A. Morse who is the Director of Research for Foundations Recovery Network

Detailed Information On The New Opiate Addict

Here is a summary of the data upon which this profile of the new opiate addict is based: Of the 1,972 patients who agreed to participate in research between January 2008 and June 2010:

– 49.8% reported opiate use within the 30 days prior to admission:

– 11.8% reported heroin use,

– 5.4% reported non-medical use of methadone, and

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Women Get Addicted

– 32.4% reported using “other opiates,” which includes nonmedical prescription opiate use.

– 8.4% of the opiate users reported using more than one type of opiate.

– The average age was 32.5 years, 59% were males and 49% were females.

– Over half (52%) reported being employed in the 30 days prior to admission; however, they also reported only working an average of 10.7 days.

– 95.8% reported receiving money from illegal activity in the month prior to treatment.

– Their average monthly income was $1,465 in the month prior, earning about $53,000 per year.

– Most spent an average of 35% of their earned monthly income on opiate drugs.

– Six months post-treatment, 73.2% of opiate users remained alcohol-free and 80.5% of were drug-free.

Opiate Use Fact Sheet

– There was a 400% increase in prescription painkillers from 1999 to 2010 (National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 2012).

– In 2011, prescription painkillers are the largest single category of illicit drug use other than marijuana (Substance Abuse and Mental Health Services Administration, 2012).

– The USA and Canada combined account for 6%, 22 tons, of the world’s heroin consumption in 2010 (United Nations Office on Drugs and Crime , 2010).

– In 2011, 4.5 million Americans over the age of 12 were current nonmedical users of painkillers and an additional 620,000 were past year users of heroin (Substance Abuse and Mental Health Services Administration, 2012).

– 1.8 million persons suffered from a pain reliever abuse or dependence in 2011 (Substance Abuse and Mental Health Services Administration, 2012).

– Opioid pain relievers accounted for 14,800 drug overdose deaths in 2008 (Centers for Disease Control and Prevention, 2011).

– The societal costs of opioid abuse, dependence and misuse including health care consumption, lost productivity and criminal justice costs and were estimated at $55.7 billion (Birnbaum, 2011).

Read the entire study on the internet.

OPIATE ADDICTION CAN BE SUCCESSFULLY TREATED

LIVE SOBER – BE RESPONSIBLE – LIFE FREE

GORSKI BOOKSGORSKI TRAINING/CONSULTATION

Read Straight Talk About Addiction
By Terence T. Gorski


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